Another court questions impartiality of doctor

A federal judge recently looked beyond the claim record and into a reviewer’s wallet in concluding that an insurer improperly terminated disability benefits. Plaintiff Igor Gunn, a financial adviser, sought disability benefits due to symptoms of multiple sclerosis, fainting spells and anxiety. After initially approving the claim, Reliance Standard terminated benefit payments after 24 months, […]

Court applies common sense to ERISA

In this short but fascinating ruling, a federal court in Florida analyzed defendant Unum Life Insurance Co.’s motion for a protective order after the plaintiff issued notices to depose Unum claims employees and one of the insurer’s doctors. The claimed basis for the protective order was Unum’s contention that the depositions would not lead to […]

Death apparently not enough to prove disability

The disability insurance policy at issue in a federal court decision acknowledged that the insurer was a fiduciary and had discretion to determine eligibility for benefits and construe the policy terms. The policy further stated that ERISA fiduciaries ”have an obligation to administer the plan prudently and to act in the interest of you and […]

Testimony presented to the ERISA Advisory Council-Working Group on health and welfare benefit plans’ communications

The current regime of treating claims administered by health and disability insurers in the same manner as pension benefit claims has proven to be a recipe for disaster. First and foremost on the agenda for fixing the current system is the need to improve the communications provided to plan participants and their beneficiaries. Judge Richard […]

Appeals court rejects ruling on tardy review

Deadlines carry little weight if there are no repercussion for missing them. Take the case of Gatti v. Reliance Standard Life Insurance Co., 2005 U.S.App.LEXIS 9895 (9th Cir., May 31), which involved a claimant who received disability benefits for nearly seven years due to complications of Hepatitis B. The insurer cut off benefits in 2000, […]

Judge takes aim at disability insurers, ERISA

In a stinging decision against an arm of the major worker disability insurer Unum Provident Corp., a federal judge charged that the Employee Retirement Income Security Act falls well short of its goals. The plaintiff, Radford Trust to which a worker’s claim was assigned, brought an ERISA claim on behalf of the trust’s beneficiary, identified […]